儿童保健-生长发育-体格发育(英文).ppt

1、CHILD GROWTH and the growth is affected by many factors, such as gene, environment and individual variation.,Attention,Weight loss: Loss of 3% 9% of birth weight in the first few days of life is considered normal and is common for most newborns.,Length/Stature,- Stature,- Length, 3y,3y,Stand,Supine,

2、Linear growth is a measurement of the vertical distance from the highest point on the head to the heel.,Increment(cm/y ),Increment（cm）,L/S (cm),Age,2yPuberty 57cm /y 57,75,12m,85,24m,50,At birth,1112,1213,25,10,10,1、 The first growth spurt occurs in the first year of life (the increment is about 25c

3、m).,2、Growth is not at the same rate in different age : The increment of weight during the first 3 months is equal to that of the following 9 months. 3 、Yearly increments increase slowly until the onset of puberty.,Patterns of Length Increment,Crown-rump/Sitting height,- Crown-rump length,Sitting he

4、ight,3y,Sit,Supine,3y,They give a measure of the length of the head and trunk. It is a measurement of the distance from the highest point on the head to the base sitting surface.,During the first year of life, spinal increase is faster than extremities. Later on, the extremities grow at a faster rat

5、e than the trunk, which is contribute to the body length and leading to a gradually change in relative proportions.,The ratio of sitting height/total height,Puberty,Defining the classification of short stature,Abnormal(Disproportionate) A syndrome with short limbs（Achondroplasia, hypothyroidism,etc）

6、,Disproportionate,Proportionate,Head Circumference,HC is a measurement of perimeter of head,from eyebrows to occipital prominence. The change of the HC is related with the growth of brain and skull.,1、 The first growth spurt occurs in the first year of life (the increment is about 12cm).,2、The incre

7、ment of HC during the first 3 months is equal to that of the following 9 months.,Patterns of HC Increment,3 、 Rapid, decelerating growth of HC . (At birth, the head is of the neonates body. By adulthood, it is only 1/8th the size of the body. ) 4 、The shape of head and circumference are affected by

8、not only diseases, but also heredity.,Small HC HC increase too fast,Cerebral dysplasia, Microcephaly,Hydrocephalus,Abnormal of HC,Growth on Puberty,Physical developments in height knee films are sometimes added for younger children(usually less than 1 year old).,Abnormality of Bone Age,Hypothyoidism

9、, Hypopituism,Precocity of BA：,Adrenogenital syndrome, Precocity,Retardation of BA：,Dentition,Primary teeth: Primary teeth are 20 totally. The first eruption is at about 6 months(410 months) . The timing of tooth eruption is more variable than other developmental parameters,Delayed eruption is usual

10、ly considered when there are no teeth by approximately 12 months of age. The last eruption of primary teeth is at 22.5 years of age.,Primary teeth,Permanent teeth,6y：First molar 78y：primary teeth are exfoliated instead by permanent teeth according to the eruption order. 12y：Second molar 18y：Third mo

11、lar Totally：32,Delayed eruption Hypothyroidism,idiopathic Disorder Hypothyroidism, Brain dysplasia Failing to erupt Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel Ectodermal dysplasia,Abnormality of Dentition,Growth and development are a continuous, series of distinct stages p

12、rocess.,Girls,Boys,Imbalance development of different systems and organs.,Individual variation,Child has rather big variation individually in growth and development, even if the identical twins, owing to some factors such as heredity, sex, environment and education etc.,An important part of well-chi

13、ld care is the assessment of a childs growth,that is to make sure that children are growing normally.,Why do growth assessment,Principles Representation of results Contents of growth assessment,Reliable and accurate data Single Value and series investigation Reference and standard,Principles,Measure

14、ment error,40,45,50,55,60,65,70,75,80,85,90,95,100,0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24,97 50 3,cm,Length,girls,Choosing reference,Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth.,Choosing ref

15、erence,Besides,there are many local or national references,for example, physical growth indices of 9 cities in China.,+2SD,-2SD,P3,P50,P97,Statistics review,Growth curve,Methods of assessment,Reference table Growth curve,Example1：（Weight of girls） P3 P25 P50 P75 P97 1y 7.49 8.54 9.18 9.91 11.37 2y n

16、y -2SD -1SD +1SD +2SD 1y 7.18 8.21 9.24 10.27 11.30 2y ny,X,Growth level Growth velocity Proportion of body,Growth level,Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age group.,Results： P97,Example：（Weight of girls） P3

17、P25 P50 P75 P97 1y 7.49 8.54 9.18 9.91 11.37 (kg) -2SD -1SD +1SD +2SD 1y 7.18 8.21 9.24 10.27 11.30 (kg) The weight of a one year old girl is 8.2 kg. Growth level：,X,X,W/A P3-P25 W/A -（1SD2SD）,0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24,97 50 3,kg,Weight，Girls,eg：An infant at th

18、e 3rd percentile of weight for age,Failing to grow Growing normally Recovering form growth failure,Attention 1,For premature infants: we should minimize the effect of gestation by subtracting the weeks of prematurity (40 weeks is considered as full term)from the postnatal age .,Attention 2,Height:40

19、m Weight: 24m Head circumference: 18m,Time for correction,Example: A girl，20m old.Weight 8.8kg，Length 79cm，HC 47.6cm. Gestational age:32Weeks.,Correcting:18m W：P3-P10 L：P20-P30,Growth velocity can show the process of growth. Growth velocity is measured in terms of how much a child grows within a spe

20、cified period of time.,Growth velocity,Serial height,Serial height,50,60,70,80,90,100,110,120,130,140,150,160,170,180,190,Boys:height,4 6 8 10 12 14 16 18,-2SD,Age ( year ),+2SD,P 97,P 3,P 50,Normal,Result representation,Normal,Descending,Accelerated,No gains,Slowed,The birth weight of a girl is 2.3

21、Kg.When she is 3 months old, the weight is 5.4Kg （Growth level： P3 ） Growth velocity： The increment of weight :3.1kg Reference:3.08Kg/0-3m Normal,Example,proportion of body,Weight to stature Trunk-leg ratio,Weight for length,W/L,Body mass index,BMI,P97,W/L: It indicates the range of weight for definite length.,The weight of a 2 years old boy is 14kg，the length is 76cm. Reference table：W/L P97,Example,BMI=W(kg)/H2(m),Example: if an 8 year old boy weighs 26.8 kg (50-75th percent